Post-Traumatic Stress Disorder Screening

People struggling with substance use disorders may have encountered various, traumatic experiences along the way. Some people who have experienced traumatic situations start using drugs and alcohol as a way to numb their feelings and cope with the emotional pain. In this case, substances are used as a way to escape. Other people, who have chronic substance use disorders, may have been traumatized after their addiction began. They may have been raped, abused, robbed, threatened, beaten, neglected, or lived in constant fear due to the drug culture in which they lived. For this person, post-traumatic stress disorder (PTSD) symptoms emerged after the drug or alcohol addiction was already in place. Either way, whether the addiction was developed before the trauma, or the addiction began secondary to the trauma, PTSD is a common, complicating part of a co-occurring disorder and must be strategically and wisely dealt with in treatment.

PTSD Secondary to Combat in Vietnam

I did my doctoral internship in a VA Medical Center in Chicago in the late 1980s. My doctoral dissertation focused on returning male Vietnam combat veterans with PTSD. I divided the Vietnam combat veterans who fit the criteria for PTSD into two groups. The first group had experienced trauma primarily in Vietnam. The second group also experienced trauma in Vietnam, as well as traumatic experiences prior to entering military services. Using a scale that I developed, I measured the amount and the severity of any childhood trauma experienced by members of either group. The premise of my dissertation was simple. The severity and amount of traumatic experiences, and the age when traumatic experiences occur all predict more severe reactions to traumatic experiences in a combat situation, compared to someone who did not have early childhood trauma. Perhaps not surprisingly, this turned out to be true; let me explain why.

Childhood Trauma Increased Adult PTSD Symptoms

If a soldier was traumatized as a child, he was more likely to have difficulty coping with combat related experiences. Many of my combat veteran clients had been abused as children. Some had been beaten, sexually abused, neglected as children, watched a parent die, witnessed murder, were involved in gangs, kidnapped, and threatened. Not only had they endured these traumatic situations, but they also had PTSD prior to combat experiences. These PTSD symptoms included recurrent, intrusive, and distressing thoughts about the trauma, as well as flashbacks, nightmares, feeling detached, being hypervigilant, and many others. Additionally, when these young men were exposed to combat they were more likely to have returning PTSD symptoms from prior experiences. This group was also likely to experience more severe PTSD symptoms than the other group.

Rates of PTSD in Co-Occurring Disorders

Those who have been traumatized in the past often use drugs and alcohol as a means of coping, and some people living in a drug-abusing environment are likely to become victims of traumatic incidents. Between 25 and 40% of those seeking substance use treatment meet criteria for PTSD. Using alcohol and drugs as an escape to self-medicate difficult emotions or to escape traumatic memories should be avoided. Substance use may provide temporary relief, but often increases severity of symptoms, creates more emotional sensitivity, interferes with treatment, causes legal problems, and creates relationship difficulties.

Developing a Questionnaire

As I work with clients with co-occurring disorders, I continue to come across those who have experienced PTSD. To understand their current level all difficulty, I developed the post-traumatic stress questionnaire. Glancing at the questionnaire, you will notice that the 10 questions are repeated. The first time through the 10 questions, the client is assessing the intensity of each experience. The second time through the same 10 questions, the client is evaluating the frequency that each symptom occurs. The scoring of the questionnaire gives you the likelihood of fitting criteria for PTSD and gives some indication of the current severity of symptoms. Use this screening information to develop the client’s treatment plan.

Post-Traumatic Stress Questionnaire

Reflecting on your past traumatic experiences, consider the following questions and using the scale below rate the intensity of each experience.

0 Not at all 1 Mild 2 Moderate 3 Severe

_____ I have trouble sleeping, falling asleep, staying asleep, or am having nightmares. _____ I feel numb, shut-down, or in a daze. _____ I feel overwhelmed and upset as I am reminded of the traumatic experience. _____ I have had less interest in my usual hobbies, interests, and activities. _____ I have been jumpy and more easily startled since the trauma. _____ I feel irritable, short-tempered, and easily frustrated. _____ I have trouble focusing, attending, and concentrating on the here and now. _____ The traumatic experience replays in my mind. _____ I feel detached and disconnected from others. _____ I am anxious or upset when I am reminded of the trauma by certain people, places, and activities.

Reflecting on those same traumatic experiences, consider the following questions and using the scale below, rate the frequency that each symptom occurs.

_____ I have trouble sleeping, falling asleep, staying asleep, or am having nightmares. _____ I feel numb, shut-down, or in a daze. _____ I feel overwhelmed and upset as I am reminded of the traumatic experience. _____ I have had less interest in my usual hobbies, interests, and activities. _____ I have been jumpy and more easily startled since the trauma. _____ I feel irritable, short-tempered, and easily frustrated. _____ I have trouble focusing, attending, and concentrating on the here and now. _____ The traumatic experience replays in my mind. _____ I feel detached and disconnected from others. _____ I am anxious or upset when I am reminded of the trauma by certain people, places, and activities.

Scoring: Add up the numbers you placed in the blanks from both groups of questions. The higher the score, the more likely PTSD symptoms are interrupting your life. The maximum total for both groups = 60.

0-14 Likely very mild or no PTSD symptoms

15-29 Likely mild PTSD symptoms

30-44 Likely moderate PTSD symptoms

45-60 Likely severe PTSD symptoms

Learning to be Sensitive

Keep in mind that people who have endured trauma may continue to be adversely affected by it. They may be more sensitive and highly reactive. Physical restraints, isolation, and threats may be triggering. Bullying, angry tones, and forceful confrontations may be misperceived and cause an increase in PTSD symptoms. People with trauma in their background need security, structure, and safety in their daily environment. Don’t minimize, discredit, or ignore the concerns of those who have PTSD. Be aware of others traumatic experiences, their resulting reactions, and then communicate respect, patience, and understanding.